1983 Cancer screening started under the Health Law for the Aged (for stomach and cervical cancer, later extended to lung, breast, endometrium, colorectum and liver)

1984 Comprehensive Ten-year Strategy for Cancer Control

1994 New Ten-year Strategy to Overcome Cancer12-Point precautions for cancer prevention1. Have a nutritionally balanced diet.2. Eat a variety of types of food.3. Avoid excess calories, especially as fat.4. Avoid excessive drinking of alcohol.5. Avoid tobacco smoking.6. Take vitamins in appropriate amounts; eat green and yellow vegetables.7. Avoid drinking fluids that are too hot and eating foods that are too salty.8. Avoid the charred parts of cooked food.9. Avoid food with possible contamination by fungal toxins.10. Avoid overexposure to sunlight11. Have an exercise program matched to your individual condition12. Keep your body clean Trends in prevalence of current smokers (1965-2005)

Men Women (%100 (% 40 ) )

80 20s

30s 20s 60 40s 50s 30s 20 60+ 40s 40 50s

20 60+ All ages All ages 0 0 2005 1995 2000

1965 1970 1975 1980

2005 1990

2000 1995 1965 1970 1975 1980 1985

1985 1990 Year YearPrevalence of current smokers for all ages in 2005: Data source: Japan Tobacco Inc.Men: 45.8%, Women: 13.8% Current issues for tobacco control in JapanLow price and tax Low price and tax compared to other developed countries Increase of price is effective especially for preventing initiation among young peopleInsufficient regulation of second hand smoke In 2003, Health Promotion Law promoted restriction of smoking in public places Need to expand smoke-free policies in hospitals, worksites and other public placesInexplicit warning labels In 2003, Finance System Council strengthened restrictions Need to make message about health dangers more explicitEasy access to cigarette among youth Banning vending machine or restricting placement of machinesFew occasions of intervention, prevention and cessation Cessation treatment covered by health insurance Increase opportunities for short interventions at health check- upsCancer screening methods according to the Health Law for the Aged (modified in 2004)Site Method of screening Interval Age (y.o.)Stomach X-ray screening (barium 1 yr 40 or more photofluorography)Cervix Cytology (Pap smear) 2 yrs 20 or more

Lung X-ray screening 1 yr 40 or more

(photofluorograpy or direct) and sputum cytologyBreast Mammography 2 yrs 40 or more + Physical examinationColon, Fecal occult blood test 1 yr 40 or moreRectum (immunological test, 2-day method)Liver HCV and HBV test once 40, 45, 50 ... Trends in number of participants in the cancer screening programs due to Health Law for the Aged

Source: Division of Health for the Elderly , Health and Welfare Bureau for the Elderly , Ministry of Health and WelfareCurrent issues for cancer screening in Japan

Lack of systematic approach to evaluate new screening methods

retrospective evaluation only need to establish infrastructure to support large-scale evaluation studiesLack of comprehensive monitoring system for participation rate covers population-based screening only occupation-based screening not coveredLow participation rate change from opportunistic screening to organized screening need to establish call/recall systemPoor quality assurance system set acceptable level of performance indicator activate quality assurance committee at prefecture levelLack of education system for health professionals poor knowledge of screening efficacy and harmsLack of education system for the public overemphasis of screening benefit Current issues for cancer care in Japan

Promotion of Improvement of cancer

therapy and cancer establishment of prevention social system1.Establishment of an effective method of 1.Strengthening the core facilities for the local preventing cancer community2.Dissemination of knowledge about 2.Standardization of cancer therapy cancer prevention 3.Improvement of QOL of patients and their3.Promotion of preventive strategy for families cancer associated with infection 4.International cooperation and cooperation4.Early diagnosis and treatment among industry, government and academia Ministry of Health Labour and Welfare May 2005

Headquarters for promoting cancer control program Minister Vice-ministers Councillors Directors of relevant Bureaus President of NCC Administrative director of NCC

Health Pharmaceutical Health Health and Health

Policy and Food Service Welfare InsuranceBureau Safety Bureau Bureau Bureau BureauHospitals, New drug approval for the Health insurancePhysicians Office Elderly of Life- Office for style Div. of the Cancer Related Health for Control Disease the elderly Control Cancer Cancer control program ScreeningAction plan 2005 Aug 2005- Promotion of cancer control program -Action 1. Re-coordinate fundamental strategy for cancer controlprogram Promoting 4 strategic approaches Promotion of cancer prevention and early detection Promotion of equalization of quality in cancer therapy Promotion of capacity building for home and palliative care Promotion of development for new technology Setting strategic indicators by site and control program

Action 2. Develop cancer information service network

Designated Cancer Care Hospitals (with Cancer Care Support Center) Center for Cancer Control and Information (CIS) in National Cancer Center

1 hospital per 1 secondary medical unit (usually

covers 300,000 population) … approximately 400 hospitals in entire Japan Nominated by the prefecture government Designated by the national government Re-designated at 2-4 year interval Designation started in 2001 … standards (2001) Revised standard (2006) Add special insurance claim and subsidiary Designation expanded from 135 to 286 (2007) Designation expanded from 286 to 351 (2008) Revised standard (2008) Network of Cancer Care System